No Surprises Act Complaint Generator

Received an unexpected bill from an out-of-network provider at an in-network facility without proper consent.

Billed for the difference between provider charges and insurance payment for a protected service.

Billed out-of-network rates for emergency services (must be covered at in-network rates).

Out-of-network air ambulance billed more than in-network cost-sharing amount.

Did not receive a Good Faith Estimate before scheduled services (uninsured/self-pay patients).

Final bill exceeded the Good Faith Estimate by $400 or more.

Billed out-of-network without required written notice and consent at least 72 hours before service.